Transcript Slide 1

Connecting Race, Place and
Health to Equity
Maryland Women’s Coalition for Health Care
Reform Conference
Mildred Thompson, Director
PolicyLink Center for Health Equity and Place
September 8, 2012
PolicyLink is a national
research and action institute
advancing economic and
social equity by
Lifting Up What Works. ®
The Center for Health Equity and Place
Where you live affects how you live.
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PolicyLink
Center for Health Equity and Place
• Research
• Capacity Building/ TA
• Convening
• Communications
• Advocacy/Action
• Thought Leadership
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Defining Health:
Overall state of physical,
economic, social and
spiritual well-being
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THE FACE OF AMERICA IS
CHANGING
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Obesity Data/Statistics – United
States*
• In 2010, African American women were 40% more
likely to be obese than Non-Hispanic White women.
• Native Hawaiian/Pacific Islanders are 2.7 times more
likely to be obese than the overall Asian American
population.
• In 2007- 2008 Mexican American children, between
the ages 6 and 17, were 40% more likely to be
overweight as Non- Hispanic White Children.
• American Indian/Alaskan Natives are 40 percent
more likely to be obese than Non-Hispanic whites.
*US Department of Health and Human Services, Office of Minority Health
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Obesity Data/Statistics – Maryland
Maryland obesity statistics*
•
2011, Maryland was ranked the 26th most obese state in the US
but 15 years ago was ranked the 23rd most obese state.
• The overall adult obesity rate in Maryland is now at 27.1%
Racial and ethnic categories show
• 36.3% obese rates among Blacks,
• 27.4% among Latinos, and
• 24.3% among Whites
Overweight and Obesity Rates for Adults by Gender, 2010**
• 59.1% of women in Maryland were overweight or obese in
comparison to 57% of women in the United States
*reported in F as in Fat from the Trust for America’s Health and Robert Wood Johnson
Foundation
**Kaiser Family Foundation State Health Facts
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Health of Women in Maryland*
• Heart disease and cancer accounted for nearly half
(48%) of all female deaths.
• The leading causes of death are the same for both
White and Black women (heart disease, cancer, and
stroke).
• Black women have higher death rates from heart
disease than white women.
• HIV is the third leading cause of death among black
women ages 25-44 years old.
*”The Health of Maryland Women 2011", produced by The Center for Maternal and Child
Health, Maryland Department of Health and Mental Hygiene (DHMH)
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Health of Women in Maryland*
• More women died from lung cancer than any other
cancer.
• Cancer mortality rates for women have declined from
2001 to 2009 by nearly 4%.
• Death rates from breast cancer were highest for
black women than all other race/ethnicities.
• Hypertension and diabetes was most prevalent
among blacks and women over 65 years of age.
*”The Health of Maryland Women 2011", produced by The Center for Maternal and Child
Health, Maryland Department of Health and Mental Hygiene (DHMH)
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Race, Class, Ethnicity and Health
African Americans,
Hispanics, Native Americans
and some Asian Americans
suffer poorer health
outcomes than whites,
regardless of S.E.S.
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Social Determinants of Health
•
Poverty, Unemployment
•
Neighborhood Conditions
•
Housing
•
Food Access
•
Parks, Physical Activity
•
Safety Concerns
•
Toxic Environment
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Making the case for Equity
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What is Equity?
• Equity means just and fair inclusion.
• An equitable society is one in which all can
participate and prosper. The goals of equity must be
to create conditions that allow all to reach their full
potential. In short, equity creates a path from hope
to change.
• Achieving equity requires intentionality, focus, and a
commitment to community engagement and
participation.
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Complexity of Health Disparities
Institutionalized
biases (racism,
sexism, etc.)
Mental Health
Social Support/
Networks
Economic
Opportunity
and Equity
Education
Background and
Opportunity
Language and
other Cultural
Factors
Environmental/
Safety and
Perception
of Safety
Belief and Trust
in Health System
Toxic Risk
Factors
Health Behaviors and
Personal Risk Factors
Access to Health
Services
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Health Inequities
Systematic and unjust distribution of social,
economic, and environmental conditions
needed for health:
•
Income
•
Employment
•
Education
•
Housing
•
Access to healthcare
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Intersection of Health, Place & Equity
Health
facilities
Access to
Healthy
Food
Schools/
Child care
Health
Community
Safety/ violence
Housing
Environment Equity
Parks/Open
Space playgrounds
Transportation
Traffic patterns
Work environments
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Communities of
Opportunity
• Parks
• Grocery Stores
• Financial
Institutions
• Better
Performing
Schools
• Good Public
Transportation
• Vibrant
healthy homes
Low- Income
Communities
Good Health
Status
Poor Health
Status
Contributes to
health disparities:
•Obesity
•Diabetes
•Asthma
• Fast Food
Restaurants
• Liquor Stores
• Unsafe/Limited
Parks
• Poor Performing
Schools
• Increased Pollution
and Toxic Waste
Sites
• Limited Public
Transportation
• Increased crime
•Increased injury
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Equitable Policies
• Equity as a criteria for inclusion and/or
prioritization of policies
• Identify policies that are important to
low-income communities, communities
of color and other vulnerable populations
specifically
• Target benefits to vulnerable populations
• Prioritize the provision of resources to
areas that need it most
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Equity Considerations in Strategy
Development
1. Is the strategy conceptualized to promote
equity/reduce inequities? If so, how? If not, how
can you modify it to specifically address inequities?
2. How will you deliberately focus on implementing
this strategy in a way that promotes equity?
3. How will your strategy promote meaningful and
authentic community engagement?
4. What inequities will be reduced as a result of this
strategy?
5. How have low-income communities and
communities of color benefited from implementing
this strategy?
6.
Identify barriers and unintended consequences
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How to Take Action
1. Ask Key Questions : who benefits, who
pays, who decides?
2. Increase Political Power of Vulnerable
Populations, including Immigrants
3. Enforce Laws that Prohibit discrimination
4. Shift Public Perceptions
5. Substantive Community Engagement
6. Target Policies that Disproportionately
Harm Vulnerable Populations
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Examples of Equity Promoting Policies
•
•
•
•
•
•
•
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Health in all policies
Health Impact Assessments (HIAS)
Healthy Food Access
Transportation Reauthorization
Joint use Agreements
Safe water and safe parks
Healthy Housing Policies
Leveraging federal resources
1. HFFI (fresh food financing initiatives)
2. Sustainable Communities
3. Promise Neighborhoods
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California FreshWorks Fund (CAFWF)
The California FreshWorks Fund (CAFWF) is a
public-private partnership loan fund modeled
after the Pennsylvania Fresh Food Financing
Initiative and aligned with President Obama’s
National Healthy Food Financing Initiative
(HFFI). It was created to:
1. Increase access to healthy food in
underserved communities
2. Spur economic development that supports
healthy communities
3. Inspire innovation in healthy food retailing
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California FreshWorks Fund (CAFWF)
Benefits:
1. Access to Healthier Food
2. New Jobs
3. Improved Property Values
4. Increased Tax Revenue
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Principles for Community
Engagement
• Empower residents through meaningful
inclusion and partnerships
• Build capacity for high level engagement
• Prioritize community knowledge and
concerns
• Target resources to support ongoing
engagement
• Facilitate mechanisms that encourage
mutual learning and feedback
mechanisms
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Towards More Equitable Public
Engagement Processes
Inclusive: What communities and
interests need to be represented and
in what capacity?
Accessible: Will people and
organizations from a diversity of
backgrounds feel comfortable and
engaged?
Transparent: How does public
engagement interact and influence
decision-making?
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Engagement and Leadership
• Efforts to achieve revitalized
communities of opportunity will not
be successful without substantial
community engagement
• Meaningful community engagement
requires participation in
governance and decision making
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Community Engagement Context
Feedback
Share successes
& challenges
Document
Progress
Host Convening
Impact
CBPR
Create Indicators
Monitor & Track
Progress
Sustainability
Investment
Commitment
Accountability
Persistence
Issue
Identify issue
Agree on
priority
Engaged
Research
Analysis & Data
Mapping
Trends
Rates
Equity &
Improved
Health
Outcomes
Community
Actions
Legislative
School board
Legal
Administrative
Institutional Communication
Message
development
Spokespersons
Media tools &
products
Partners
Agencies
Policymakers
Businesses
Schools
Churches
Affirm
Solutions that
work
Strengths/Cap
acity
Explore
Solutions
Advocacy
Policy
System Change
Barriers
Challenges
Contribution
Perceptions
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Institutional Structures for
Community Engagement
Ascending
Impact
Governance
Level
Consortia
Advisory
Groups
Task forces
Focus
Groups
Town Hall
Meetings
• Appointment to decision making boards and
commissions
• Membership based group with options for decision
making
• Provide guidance and advice to decision makers
• Short term participation with opportunity to offer
recommendations
• One-time opportunity to provide input
• Information provided one time, sometimes an
ability to offer group comments
Descending
Impact 37
Getting Equity Advocacy Results (GEARS)
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Measuring Health Equity
1) Measurement of community conditions
relevant to health
2) Measurement of the implementation of
strategies, campaigns, policies and plans
3) Measurement of health behaviors and
health outcomes
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'Of all the forms of
inequality, injustice in
health care is the most
shocking and most
inhumane' - Martin
Luther King, Jr. (March
25, 1966)
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Thank you!
Mildred Thompson, Director
PolicyLink Center for Health Equity and Place
www.PolicyLink.org